ATTACHMENT H NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 17 KB Posted
- Attached to
- R499--Furniture Install and warehousing
- Solicitation number
- 36C25623Q1401
About this file
This document is an Attachment H Notification of Compliance with Insurance Requirements for solicitation number 36C25623Q1401 for furniture installation and warehousing services. The contractor acknowledges that they have read and understand the insurance requirements specified in the contract and agree to maintain at least the amounts and types of insurance coverage specified. The policies will contain an endorsement that any cancellation or material change will not be effective for the period prescribed by state law where the contract is performed or 30 days after the insurer or contractor provides written notice to the contracting officer, whichever is longer. The contractor also agrees to maintain applicable state workers' compensation insurance or a letter of reciprocal agreement and to provide copies of subcontractor insurance upon request.
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Text version
ATTACHMENT H – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25623Q1401
NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
The undersigned Contractor hereby acknowledges that he or she has read and understands the insurance requirements specified in this contract and hereby agrees (1) that such insurance will be maintained in at least the amounts and types specified in this contract and during any modifications and or time extensions granted thereto; (2) that the policies evidencing required insurance shall contain an endorsement to the effect that any cancellation or any material change adversely affecting the Government's interest shall not be effective for such period as the laws of the State in which this contract is to be performed prescribe, or until 30 days after the insurer or contractor gives written notice to the Contracting Officer, whichever period is longer; (3) that ________________ (State) Workmen's Compensation Insurance, or letter of reciprocal agreement with another state, shall be maintained on this contract for and during the entire performance period and for any modifications and time extensions granted thereto; and (4) that a copy of all subcontractors’ proof of insurance shall be maintained and shall be made available to the Contracting Officer upon request. This agreement shall become a part of the above referenced contract file.
INSURANCE COMPANY(S): ____________________________________
(NAME[S]) (TELEPHONE NUMBER[S]): ______________________________________________
CONTRACTOR: ____________________________________________
(NAME): __________________________________________________
(ADDRESS): _______________________________________________
(AUTHORIZED SIGNATURE) (DATE): _______________________________________________
(TYPED NAME AND TITLE):________________________________________________________
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